居家機構應用自立支援照顧於失能個案效益之研究

在傳統的照護模式，機構傾向以「被照顧者的安全」與「照顧者管理之方便有效」為優先考量，進行約束、臥床與包尿布，導致受照顧者產生廢用症（disuse syndrome），身體功能退化變快，生活品質下降。相對地，若採用自立支援照顧模式，對失能者之照顧結果也許不同。基於此，本研究目的在探討機構應用自立支援照顧失能者的動機、執行狀況、對個案的成效及對機構的效益等。為達上述研究目的，研究者以立意取樣的方式，選取台中市幸福村居家長照機構之護理師、輔導員、照顧服務員各一位，共3位為研究參與者，採質性研究之深度訪談法進行資料蒐集與分析。研究結果為：（1）機構應用自立支援照顧失能者的動機為自立支援照顧模式較傳統照顧上較可以協助長者維持自主尊嚴及基本生活品質；（2）執行狀況為應用自立支援照顧協助失能者達成四要（喝水、飲食、運動、排泄），三去一不（去尿布、去管路、去約束、不臥床）目標。其中，有二位受訪者認為「不臥床」達成目標較為困難的，耗時、耗心力且需長時間持之以恆才能達成，另外一位受訪者則認為去管路（鼻胃管）比較困難，主要是因為需醫療護理，還需口腔運動訓練，且吞嚥動作等之照顧程序比較繁多；（3）個案成效：個案透過自立支援照顧後，從臥床到可以自行走路；右側中風的個案，在接受輔導之後可以右手寫字；（4）機構效益：機構落實員工自立支援照顧技能，贏得好的服務品質與名聲，並獲得臺中市金照獎。最後，本研究依研究結果，對相關單位與後續研究者提出建議，期待未來在自立支援照顧下，失能者皆能提昇晚年生活品質。

關鍵字

自立支援照顧；長期照護；居家機構

並列摘要

In traditional care mode, institutions tend to give priority to "safety of caregivers" and "convenient and effective caregiver management". The care mode is restrained, bedridden and wrapped diapers, resulting in disuse syndrome, rapid deterioration of body function, and quality of life. The purpose of this study is to explore the motivation, operation status, effectiveness of individual cases and benefits for institutions to apply self-supporting care to disable elders. In order to achieve the above research purposes, the researcher selected the home long-term care agency of Happiness Village in Taichung City as the main research object, including one nurse, one counselor and one care service worker and adopted the in-depth interview method of qualitative research for data collection and analysis. The research results were: (1) The motivation of the institution applying self-supporting care on the disable elders was to maintain their independent dignity and basic quality of life; (2) The operation status was to help the disable elders achieve four essentials (drinking water, diet, exercise, excretion) and three targets (diaper removal, tube removal, restraint removal, and ambulatory status). Among them, two interviewees thought that it was difficult to achieve the ambulatory goal, which would take a lot of time, efforts and perseverance. The other interviewee thought it was difficult to remove the tube (nasogastric tube). Mainly because medical care was required, oral exercise training was also required, and there were many care procedures such as swallowing. (3) Case outcomes: After being cared for by self-reliance support, the disable case went from bedridden to walking on his own. Besides, for right-side stroke case, after receiving counseling, he could write with his right hand. (4) Institutional benefits: The institution has implemented employee self-reliance support and care skills, won good service quality and reputation, and won the Taichung City Golden Photo Award. Finally, based on the research results, this study puts forward suggestions to relevant units and follow-up researchers, hoping that future caregivers can improve disable elders with good quality of life based on the self-supporting care.

並列關鍵字

self-supporting care ； long-term care ； home long-term care agency

參考文獻

王文科、王智弘(2010)。質的研究的信度和效度。彰化師大教育學報，(17)，29-50。 doi: 10.6769/JENCUE.201006.0029

林立金、余彥儒(2017)。自立支援照顧的臺灣實踐，長期照護雜誌，21(1)，15-18。 doi: 10.6317/LTC.21.15

吳文瑞、賴婉淑、許菀真、雷若莉、葉庭妤(2020)。自立支援活動在長照機構成效－中部某機構報告，物理治療，45(2)，151-152。 doi: 10.6215/FJPT.202006.P22

張文筠(2015)。年金改革後南投縣國小教師工作價值觀與生涯規劃關係之研究。國立暨南國際大學終身學習與人力資源發展所。 doi: 10.6837/ncnu202000156

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